Abstract
Background
Uterine fibroids are the commonest tumour of the female genital tract; about one third
are symptomatic and require management. The treatment of uterine fibroids may be medical,
surgical, conservative or expectant. Myomectomy is the common surgical treatment option
for women failing medical management and desiring to preserve fertility and/or their
uterus. The tourniquet is shown to be effective in reducing blood loss during myomectomy
and tranexamic to a less extent. However, the adjunctive use of tranexamic acid with
tourniquet to further reduce blood loss has not been studied.
Aim
The aim of the study was to determine the efficacy of perioperative intravenous tranexamic
acid in further reducing blood loss at abdominal myomectomy when used as an adjunct
to tourniquet.
Methods
The study was a randomized double-blind controlled study involving women who underwent
abdominal myomectomy. Participants were randomized to either tourniquet plus intravenous
tranexamic acid or tourniquet plus placebo groups using simple random sampling. The
primary outcomes were the intra-operative blood loss, post-operative haematocrit values
and need for intra-operative blood transfusion. The data was analyzed using the SPSS
software version 23.0 and p value < 0.05 was significant.
Results
The mean intra-operative blood loss (998.72 ± 607.21 ml vs 907.25 ± 529.85 ml, p = 0.475), intra-operative blood transfusion rate (45% vs. 30%; p = 0.166) and mean unit of blood transfused (1.13 ± 1.64 vs. 0.75 ± 1.28; p = 0.256) were higher for tourniquet plus placebo group compared to tourniquet plus
tranexamic acid group. The estimated blood loss per 100 g of fibroid removed was reduced
significantly in the tranexamic acid plus tourniquet group (139.80 ± 2.28 ml vs 104.09 ± 1.97 ml;
p = 0.001).
Strength and limitations
: The strength of the study include randomization and blinding. The limitations included
non-uniformity of sizes and locations of fibroids, as well as the different surgeons
with possibly different skills, techniques and experiences, though they were statistically
not significant.
Conclusion
The adjunctive use of tranexamic acid to tourniquet significantly further reduces
intraoperative blood loss during abdominal myomectomy when compared to tourniquet
alone.
Recommendations
Adjunctive use of tranexamic acid is recommended for further reducing intra-operative
blood loss during abdominal myomectomy.
Keywords
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Article info
Publication history
Published online: September 25, 2019
Accepted:
September 18,
2019
Received in revised form:
August 12,
2019
Received:
February 26,
2019
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
